Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . s-appear with restoration of cardiac energy, Popoff attributes theinequality to pressure of the greatly dilated left auricle on the leftsubclavian artery. Preble has also noticed its occurrence in someof his cases. As pulsus differens may also be produced by aneu-rysm, embolism, thrombosis, arteriosclerosis, etc., it is important that all such causes be ex-cluded before the phenomenonis attributed to extreme dila-tation of the auricle, a mat
Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . s-appear with restoration of cardiac energy, Popoff attributes theinequality to pressure of the greatly dilated left auricle on the leftsubclavian artery. Preble has also noticed its occurrence in someof his cases. As pulsus differens may also be produced by aneu-rysm, embolism, thrombosis, arteriosclerosis, etc., it is important that all such causes be ex-cluded before the phenomenonis attributed to extreme dila-tation of the auricle, a matterthat may be of some momentin prognosis. Percussion shows a simi-lar change in absolute andrelative cardiac dulness as de-scribed in the article on mi-tral regurgitation—viz., anincrease of cardiac dulnesstowards the right side anddownward (Fig. 45). Thisincrease bears a direct rela-tion to the degree of to Leube, percus-sion shows a more pronouncedenlargement of the right heart in this form of mitral disease thanin insufficiency, a point he regards as of importance in the differ-ential diagnosis between these two Fig. 45.—Location of Apex-beat andArea of Deep-seated Dulness in Mi-tral Stenosis. MITRAL STKXOSIS 261 Another difference lies in the fact that, owing to atrophy in-stead of hypertrophy of the left ventricle, dillness is not likely tobe much if at all increased to the left. Auscultation.—In pronounced cases of mitral stenosis, auscul-tation at the apex of the heart detects a murmur of such intensityand distinctive character that it at once fastens the attention ofthe examiner. In most instances it is a long-drawn, rough bruit,which, beginning after the second sound, runs up to and termi-
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